Joining Forces for Future Health

Outcome Statement
The Hague ministerial meeting
“Joining Forces for Future Health”
25-26 June 2014
We, the ministers of health and agriculture and other representatives of Member States of the
World Health Organization (WHO), together with the Directors-General of WHO, OIE and FAO and
the European Commissioner for Health and Consumer Policy have gathered in The Hague, The
Netherlands on 25 and 26 of June 2014 to discuss ways to respond to the challenges posed by the
threat of antimicrobial resistance and the need for global action.
In reference to Resolution WHA67.25 we agree that antimicrobial resistance is an increasing
urgent global health threat. Resistance to antimicrobials places much of the progress made in
health care and medicine over past decades at significant risk. Reducing antimicrobial resistance
will require a One Health approach combing efforts of many stakeholders and sectors, especially in
the fields of health, agriculture and aquaculture to work together using synergistic and
complementary approaches. The effectiveness and future use of antimicrobials must be preserved
for the treatment of human and animal diseases.
We fully endorse the urgent need of a Global Action Plan for antimicrobial resistance as called for
by the World Health Assembly in May 2014. We will actively contribute to the development and
implementation thereof. We further call for the UN General Assembly High Level Meeting
mentioned in resolution to take place in 2016 to enable timely high level follow up to the Global
Action Plan.
In our meeting we discussed that:
a. an effective Global Action Plan identifies stepwise strategies to the reduction in prevalence of
antimicrobial resistance;
b. in line with the development of a Global Action Plan, action at the national and regional level
are essential in order to diminish the threat of antimicrobial resistance. We stress the special
responsibility of ministers of health to provide leadership in and also champion the
establishment of a cross governmental approach in combating antimicrobial resistance;
c. the Global Action Plan needs to allow for tailor made implementation in cross-sectoral national
plans for antimicrobial resistance as capacities, priorities and concerns will vary across
different countries, regions and sectors;
d. improving public awareness and, at all levels of healthcare as well as at veterinary
professionals, capacity building, good governance, legislation and functioning public health and
veterinary services are required to implement measures and surveillance;
e. measures to reduce antimicrobial resistance should be taken in the context of appropriate
health systems;
f. because antimicrobial resistance is such an urgent global health threat, measures could be
taken based on the precautionary principle, even though scientific evidence for possible
measures is not always available;
g. while we are observing increasing rates of viral, bacterial and fungal strains that are resistant
to drugs, we are particularly concerned with the rise in drug resistant bacteria;
h. there are linkages between the use of antimicrobials in animals and the threat of resistance in
humans and animals;
i. the use of antimicrobials in human and veterinary medicine has to be prudent and restrained;
j. improvement of hygiene, infection prevention monitoring and control programmes are
essential pillars for prevention of antimicrobial resistance;
k. in the rearing of animals, the need for antimicrobials can be reduced by improved hygiene
measures, management and vaccination;
l. the presence of antimicrobials and antibiotic resistant bacteria in the environment is a matter
of concern;
m. improving the quality and sharing of national surveillance data will improve the global
understanding of the spread of antimicrobial resistance; national and global actions to prevent
the spread of antimicrobial resistance can be based on that insight;
1
n.
o.
for decades no new classes of antibiotics have been developed; the world lacks a robust
pipeline of new and next generation antibiotics, and
the development and use of rapid, point-of-need diagnostics to identify and characterize
bacterial resistance are needed.
We welcome the advice and recommendations of the ‘Strategic and Technical Advisory Group for
Antimicrobial Resistance’ which advises WHO on the coordination role it should be playing in the
fight against AMR.
We concluded that, among others, the following priorities should be addressed in the Global Action
Plan:
1. the development and implementation of national and global measures and intergovernmental
standards for infection prevention and the prudent and restrained use of antimicrobials, in
both human and veterinary medicine and the development of new antibiotics;
2. the need for a stepwise multi-sectoral approach to enable all countries, especially developing
countries to strengthen their capacities and to make progress to achieve better control of
antimicrobial use and resistance at all levels;
3. the health sector, the veterinary, agricultural and environmental sectors, national
governments and international organisations must work together to achieve:
a. improve transparency in governance of measures to combat antimicrobial resistance;
b. specified, controlled and restrained use of antimicrobials in human and veterinary medicine,
c. harmonised and standardised surveillance systems to make transparent the national use of
antimicrobials and prevalence of antimicrobial resistance in human and veterinary
medicine, and
d. antimicrobial management under supervision of appropriately trained professionals,
e. a common position on the topic of reservation for human use of newly developed
antimicrobials and of last resort antimicrobials for human health;
f. the need to engage and support primary food animal producers and other value chain
stakeholders in the adoption and implementation of good animal husbandry, health and
hygiene measures with the aim of reducing usage of antibiotics in animal (terrestrial and
aquatic) production;
4. implementation of new innovative ways, such as public private partnerships, to facilitate the
development of new antimicrobials and other technologies including diagnostics and vaccines
and alternative approaches, as well as strategies for controlled distribution and use thereof;
5. the need to raise awareness on antimicrobial resistance and to promote judicious use of
antimicrobials in both the general public, civil society organisations and at all levels of
healthcare and veterinary professionals;
6. the urgent need for collaborative research to strengthen the evidence on the magnitude,
epidemiology and economic impact of antimicrobial resistance and the effectiveness of control
measures;
7. the need for nations to work together to develop the scientific input necessary to reduce
antimicrobial resistance, including by supporting the research and development for new and
next generation antimicrobial agents, interventions and rapid diagnostics;
8. the need to set up an economic analysis of costs involved of AMR for health care, and the costs
and benefits of implementing strategies to achieve a restrained and prudent use of antibiotics
in the human and animal sector, and
9. the establishment of a global Antibiotic Awareness Day.
As a follow up of the foreseen adoption of the Global Action Plan in 2015, a high level United
Nations meeting on antimicrobial resistance, as proposed in WHA67.25, 1.(4), could take place in
2016, involving all key partners. We call upon all stakeholders to share best practises and join
forces for future health!
2
The following countries have committed themselves to follow up actions of multi-sectoral concern:
Ghana is hosting an African conference on antibiotic use and resistance titled “Who is winning the
antibiotic resistance war – bacteria or man?” in November 24-26 2014 in Accra as a contribution to
the Global Action Plan.
Indonesia will in the context of the Global Health Security Agenda organize a meeting on
Emerging Infectious Diseases.
Norway will host a meeting on the use of antimicrobials in end October/start November in cooperations with the WHO, South Africa, France and Thailand. The meeting will take place in Oslo as
a part of the preparation of the Global Action Plan.
Oman is planning to conduct an international conference on antimicrobial resistance for countries
in the WHO EMRO region. The plan is to conduct the meeting in the first half of 2015. The ministry
of Health of Oman will conduct the conference in collaboration with WHO EMRO, WHO HQ, FAO and
OIE. The aim of the conference will be to raise the awareness of antimicrobial resistance amongst
the stakeholders of concern with regards to antimicrobial resistance in both human and animals. In
addition, the aim is to come up with a regional declaration and an action plan for the legislation
and use of antibiotics in human and in the animal and agricultural industry.
Sweden will host a technical meeting on global surveillance in the last quarter of 2014. The
meeting aims to strengthen surveillance as a tool to measure the burden of antimicrobial
resistance and to evaluate the effects of measures taken to stop further spread of resistance. It
will further develop tools for global surveillance, ways to implement them in all Member States and
get commitment to start sharing surveillance data.
United States of America is committed to working domestically and internationally to preserve
the global benefit of antibiotics and to prevent, detect, and control illness and death related to
antibiotic resistant infections by implementing measures to mitigate the emergence and spread of
antibiotic resistance. Effective global action to achieving these goals is an essential component of
strengthening global health security. In support of the development of the WHO Global Action Plan,
the United States will host an international meeting at the White House on September 26, 2014 to
promote global health and global health security; as part of the Global Health Security Agenda
being undertaken by a number of Member States in cooperation with WHO, FAO and OIE.
3

Download Report